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An Examination of Acupuncture Psychophysical Response (De Qi) Parameters, Scales and Implications for Clinical Practice

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An Examination of Acupuncture Psychophysical Response (De Qi) Parameters, Scales and Implications for Clinical Practice An Examination of Acupuncture Psychophysical Response (De Qi) Parameters, Scales and Implications for Clinical Practice Shohreh Razavy BHlthSc (TCM), BSc (Geology) A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Faculty of Science University of Technology Sydney Australia August 2019 Certificate of original authorship I certify that the work in this thesis has not previously been submitted for a degree nor has it been submitted as part of requirements for a degree except as fully acknowledged within the text. I also certify that the thesis has been written by me. Any help that I have received in my research work and the preparation of the thesis itself has been acknowledged. In addition, I certify that all information sources and literature used are indicated in the thesis. This research is supported by the Australian Government Research Training Program. Production Note: Signature removed prior to publication. Shohreh Razavy 7th August 2019 i Acknowledgements This thesis would not have come to a successful completion without the academic, scientific, and technical assistance, contribution and support from many individuals. My sincere appreciation goes to: My principal supervisor, Associate Professor Christopher Zaslawski, for the constant optimism and support throughout this long journey as well as his patience, motivation, and immense knowledge. Chris has given me all the freedom to pursue my research as well as allowing me to grow as a researcher, while positively and respectfully ensuring that I do not deviate from the core of my research. It should also be acknowledged that Chris was kind enough to undertake the editing work of each chapter of this thesis meticulously. The Associate Dean of Research, Professor Alaina Ammit, for her approval regarding the preparation of my thesis in the format of Thesis by Compilation. My co-supervisor, Dr Weihong Li, for being my secondary supervisor and providing the acupuncture treatment during the trial. The Tennis Elbow Acupuncture – International Study – China, Hong Kong, Australia and Italy (TEA-IS-CHAI) research teams, and in particular, Associate professor Shipping Zhang from School of Chinese Medicine at Hong Kong Baptist University for sponsoring my first manuscript to be published in the Journal of BMC. My colleague, Dr Bertrand Loyeung for providing his heartfelt support, invaluable guidance and inspiration at all times throughout my candidacy. I would also like to extend my thanks to Dr Sean Walsh for providing me invaluable advice on both future research opportunities, and my career. Ms Helen Chan, team leader for both teaching-learning and research support at UTS Library, for sparing her valuable time whenever I approached her in my quest for knowledge regarding database search strategies for my systematic review manuscript. ii Ms Shannon Hawkins and Ms Maggie Chen who greatly supported and assisted me with the administration of my candidacy during my PhD. All my friends from different disciplines; Traditional Chinese medicine, Mathematical and Physical Sciences, Environmental Science at UTS University who provided a much-needed form of escape from my studies, also deserve thanks for helping me keep things in perspective, in particular, Dr Nikta Shahcheraghi for her tremendous encouragements during my candidacy, and Paras Sidiqui for enlightening advice regarding my thesis structure. Finally, but by no means least, thanks go to my parents, my mother-in-law, my sister and my brothers for supporting and encouraging me throughout this experience. I am very much indebted to my beloved husband, Dr Mohammad Abdollah, who supported me in every possible way to see the successful completion of this work. iii Summary of thesis According to the theory of traditional Chinese acupuncture, acupuncture psychophysical responses (De-Qi) is a fundamental characteristic of acupuncture and believed to be indicative of a successful therapeutic acupuncture treatment. The phenomenon is understood to represent a constellation of subjective unique psychophysical responses of varying characteristics during the administration of acupuncture. Certain sensory responses are also thought to serve as an indicator for the dose of acupuncture needling. Qualities or characteristics of these sensory responses are often utilised to perform quantitative evaluation of acupuncture dosage. Hence, to ascertain the acupuncture-specific effects in an optimal way, it is essential to investigate this complex phenomenon into its constituent components. Furthermore, preliminary investigations indicate interoception to be reflective of De-Qi. Studies have reported that exposure of individuals to an unfamiliar situation or experimental study may cause anxiety, which is likely to influence sympathetic nervous system activity. It is also proposed that environmental or interoceptive signals are linked with a perceived sense of threat in anxious individuals which in turn may affect the perception of De-Qi in clinical settings. Recently several measures have been developed to quantify the potency and characteristics of the De Qi, as it is often reported that one of the major criticisms of acupuncture remains the lack of scientifically acceptable data and measurable efficacy. With this in mind, this dissertation examines the psychophysical responses experienced during acupuncture within the context of an acupuncture randomised clinical trial. At the same time, the thesis highlights the importance of understanding interoception and in particular the role of self-awareness, which may contribute to the placebo effect, and psychophysical responses that are often observed in clinical studies. Additionally, the role of pre-operative or situational anxiety in the elicitation of the acupuncture psychophysical responses was investigated. The study also investigates the influence of culture on individuals’ perception of acupuncture sensory responses and provocation of negatively valanced emotions such as situational anxiety. Finally, the thesis systematically and critically appraises all the existing scales developed to quantify acupuncture psychophysical responses by adhering to published guidelines such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and COnsensus- based Standards for the selection of health Measurement INstruments (COSMIN) quality criteria guidelines. iv Publications Razavy, S., Loyeung, B.Y.K., Walsh, S. & Zaslawski, C. 2019. Evaluation of Psychometric Properties of acupuncture psychophysical response (De Qi) Scales: A Systematic Review Study. Under review: Submitted to the PLOS One Journal. Gadau, M., Zhang, S.P., Wang, F.C., Liguori, S., Zaslawski, C., Liu, W.H., Bangraz, S., Berle, C., Bian, Z.X., Filomena, P., Hao, Y., Jiang, H.L., Lei, L., Li, T., Li, W.H., Liguori, A., Liu, Y.S., Lu, A.P., Razavy, S., Tan, Y.S., Yim, W.W., Xie, C.L. A multi-center international study of Acupuncture for lateral epicondylitis - Results of a randomized controlled trial. Submitted to the Journal of Clinical Pain. Razavy, S., Gadau, M., Zhang, S.P., Wang, F.C., Bangrazi, S., Berle, C., Li, T., Li, W.H. & Zaslawski, C. 2018. Anxiety Related to De Qi Psychophysical Responses as Measured by MASS: A sub-study embedded in a Multisite Randomised Clinical Trial, Complementary Therapies in Medicine, 39, 24-35. Razavy, S., Gadau, M., Zhang, S.P., Wang, F.C., Bangrazi, S., Berle, C., Harahap, M., Li, T., Li, W.H. & Zaslawski, C. 2017. Investigation of the phenomenon of Propagated Sensation along the Channels (PSCs) in the upper limb following administration of acupuncture and mock laser, Journal of Acupuncture and Meridian Studies, 10, 307-316. *Razavy, S., Gadau, M., Zhang, S.P., Wang, F.C., Bangrazi, S., Berle, C., Harahap, M., Li, T., Li, W.H. & Zaslawski, C. 2017. Psychophysical responses in patients receiving a mock laser within context of an acupuncture clinical trial: An Interoceptive perspective, BMC Complementary and Alternative Medicine, 17, 1-14. Razavy, S., Berle, C., Li, W, & Zaslawski, C., 2014, The measurement of deqi within an acupuncture clinical trial using three different instruments, Journal of Integrative Medicine, Poster Abstract, 3, 210. ___________________________________ * Paper of the month: July 2017, School of Science. v Donnelly, S., Dean, S., Razavy, S. & Levett-Jones, T. The Refuge Project: Mapping empathy level changes in Health, Architecture and Landscape students. Submitted to the International Journal of Higher Education. Presentations Oral Presentations Razavy, S. 2017. “Psychophysical Placebo Responses in Patients Receiving a Mock Laser (ML) Intervention: An Interoceptive Perspective”, Australasian Acupuncture & Chinese Medicine Annual Conference, 5-7th May 2017, Brisbane Convention and Exhibition Centre, Australia. Razavy, S. 2015. “Psychophysical Placebo Responses in Patients Receiving a Mock Laser (ML) Intervention: An Interoceptive Perspective”, New Horizons-32nd Combined Health Science Conference, 23-25th November 2015, University of Technology Sydney, Australia. Razavy, S. 2015. “Psychophysical responses in patients receiving inactive laser within context of an acupuncture clinical trial: An interoceptive perspective”, Chinese Medicine and Acupuncture Research Forum (Chengdu University of Traditional Chinese Medicine and University of Technology Sydney), 2015, University of Technology Sydney, Australia. Poster presentation Razavy, S., Berle, C., Li, W.H., & Zaslawski, C. 2014. “The measurement of De Qi within an acupuncture
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